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In recognition of National Women's Health Week (May 9-15, 2004), the
National Maternal and Child Oral Health Resource Center (OHRC) has
released a new fact sheet, Oral Health and Health in Women: A Two-Way
Relationship. OHRC produced the fact sheet in collaboration with health
professionals, program administrators, educators, and researchers in
the fields of oral health and women's health. The fact sheet provides
general information and national data on women’s oral health. Topics
include women’s oral health status, the relationship between oral
health and general health in women, oral health care, and strategies
for improving women’s oral health. The fact sheet is available at http://www.mchoralhealth.org/PDFs/WomensFactSheet.pdf.

Readers: National Women's Check-Up Day will be held on May 10 to
encourage women to use the many high-quality preventive care services,
including oral health care services, available to them through the
nation's health centers. More information is available from the
National Women's Health Week Web site at http://www.4woman.gov/whw/2004.

Forging a Poison Prevention and Control System examines the future of
poison prevention and control services in the United States. The
Maternal and Child Health Bureau of the Health Resources and Services
Administration asked the Institute of Medicine (IOM) to help develop a
more systematic approach to understanding, stabilizing, and providing
long-term support for poison prevention and control services. IOM
examined the role of poison control services within the larger public
health system, the injury prevention and control field, and the fields
of general medical care and medical and clinical toxicology. IOM also
looked at how poison control centers function relative to the functions
performed by other health care agencies and government organizations.
The report provides information on the magnitude of the problem; the
historical context of poison control centers; center activities,
personnel, and quality assurance; current costs, funding, and
organizational structures; data and surveillance; and prevention and
public education. Conclusions, recommendations, a list of contributors,
and committee biographies are also included. The pre-publication
version of the report is available at http://books.nap.edu/books/0309091942/html/index.html.

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3. EXPERT PANEL EVALUATES REPRODUCTIVE AND DEVELOPMENTAL TOXICITY OF
WIDELY PRESCRIBED ANTIDEPRESSANT IN WOMEN AND CHILDREN

"The Expert Panel concluded that there is sufficient evidence in humans
to determine that prenatal exposure to fluoxetine [Sarafem, Prozac]
results in poor neonatal adaptation . . . at typical therapeutic
exposures (20-80mg/day orally) during the third trimester of
pregnancy," state the authors of a report published by the Center for
the Evaluation of Risks to Human Reproduction. Fluoxetine is an
antidepressant that is widely prescribed in the United States. The
report evaluates evidence for adverse effects on reproduction
(including development) caused by fluoxetine exposures among women of
childbearing age and among children.

The Fluoxetine Expert Panel, a twelve-member panel of government and
nongovernment scientists, conducted an evaluation to (1) interpret the
strength of scientific evidence that fluoxetine is a reproductive or
developmental toxicant, (2) assess the extent of human exposures, (3)
assess the scientific evidence that adverse reproductive or
developmental health effects may be associated with such exposures, and
(4) identify knowledge gaps. The evaluation culminated in a public
expert panel meeting held on March 3-5, 2004.

The panel found that

* Third trimester exposure to therapeutic doses of fluoxetine (20-80
mg/day orally) is associated with an increased incidence of poor
neonatal adaptation (e.g., jitteriness, hypoglycemia, hypothermia, poor
tone, respiratory distress, weak or absent cry, diminished pain
reactivity, or desaturation with feeding).
* The evidence suggests that developmental toxicity can also occur in
the form of shortened gestational duration and reduced birthweight at
term.
* There is sufficient evidence that fluoxetine can produce reproductive
toxicity in men and women as manifested by reversible, impaired sexual
function, specifically orgasm.
* The mechanism by which fluoxetine can cause reproductive and
developmental toxicity is unknown.
* There are insufficient data to draw conclusions about drug-induced
toxicity in infants exposed to fluoxetine through breast milk or about
children on fluoxetine therapy.

The authors note that a monograph on fluoxetine is forthcoming and will
include a brief, this report, and all public comments on the report.
The monograph will be made publicly available and will be transmitted
to appropriate health and regulatory agencies.

"Overall, employer-provided health insurance coverage fell from 1999 to
2002, almost entirely because of falling dependent coverage, largely
among children," state the authors of Improving Access to Health
Insurance, a data brief published by the Center for Economic and Policy
Research (CEPR). The brief is the first of a five-part series by CEPR
on health insurance in the United States. The brief addresses access to
health insurance and describes policy options available to expand
coverage to Americans who did not have health insurance during 2002.
Other briefs in the series examine health insurance coverage generally,
employer-provided health insurance for employees, changes in the share
of Americans receiving employer-provided health insurance as a
dependent on another family member's plan, and interactions between the
private and public health insurance systems.

The data used in the series comes from CEPR's analysis of the Survey of
Income and Program Participation. The authors explored demographic
trends and identified major problems. They also evaluated various
policy solutions offered by Congress and major party presidential
candidates.

The authors found that

* Access to employer-provided health insurance coverage fell from 64.0%
in 1999 to 61.6% in 2002.
* Between 1999 and 2002, the share of workers with employer-provided
health insurance who cover another family member fell from 56.0% to
51.6%. The decline was larger among children than among adults.
* Less than half (47.4%) of low-wage workers had any employer-provided
health insurance during all of 2002.
* Between 1999 and 2002, the share of children covered for the whole
year (by any source) fell from 74.9% to 71.4%.
* Latinos are less likely than other racial/ethnic groups to be covered.
* Among adults, young adults (ages 18 to 25) are the least likely to
have health insurance.

"Increasing access to health coverage and ensuring equity in
eligibility are two achievable goals," the authors conclude. They
suggest that "future legislative solutions must focus on increasing
access to health insurance as well as ensuring equity across age, race,
and income levels."

5. AUTHORS ASSESS EVIDENCE OF EFFECTIVENESS OF PHYSICIAN INTERVENTIONS
IN PREVENTING AND MANAGING DENTAL CARIES IN PRESCHOOL-AGE CHILDREN

"The evidence base for recommendations to physicians about dental
caries prevention in young children needs to be strengthened," state
the authors of an article published in the April 2004 issue of the
American Journal of Preventive Medicine. The article presents a summary
of evidence for the U.S. Preventive Services Task Force (USPSTF) on the
effectiveness of primary care clinician-based interventions for
preventing dental caries in preschool-age children.

Researchers searched MEDLINE for the period 1966 to October 2001. The
literature review focused on studies addressing the performance of
primary care clinicians in five essentially dental roles: (1) screening
and risk assessment, (2) referral, (3) provision of dietary fluoride
supplementation, (4) application of fluoride varnish, and (5)
counseling.

The authors found that

* The strength of the evidence assessing the effectiveness of screening
and risk assessment, referral, and counseling is poor.
* The strength of the evidence assessing the appropriateness of primary
care clinicians' prescription of supplemental fluoride is fair, but it
suggests that physicians' decisions about fluoride supplements might
not always be made with full knowledge of a child's other fluoride
exposures.
* The strength of the evidence assessing the effectiveness of dietary
fluoride supplementation and fluoride varnish is also fair; however, no
studies on the effects of the most recently recommended regimen for
fluoride supplementation are available.

The authors conclude that "evidence for the effectiveness of
traditionally recommended primary care clinician interventions
(screening, referral, counseling) to prevent dental caries in preschool
children is lacking." They add that although there is fair evidence for
the effectiveness of fluoride supplementation and fluoride varnish,
"there is also evidence indicating that physicians' consideration of
fluoride exposure is incomplete, thus increasing the risk for fluorosis
among those prescribed supplements."

Readers: The USPSTF concluded that the benefits of dietary fluoride
supplementation outweigh the potential harm of fluorosis, which in the
United States is primarily observed as a mild cosmetic discoloration of
the teeth. The task force recommendations, based on this review, are
available at http://www.ahrq.gov/clinic/3rduspstf/dentalchild/dentchrs.htm.

Additional information about the prevention and management of dental
caries in infants and children from birth to age 5 can be found in the
Early Childhood Caries Resource Guide (2nd ed.), available at http://www.mchoralhealth.org/PDFs/EarlyChildCaries.pdf.
The resource guide was published by the National Maternal and Child
Oral Health Resource Center and is designed to assist policymakers,
program administrators, health professionals, and others in the
prevention of early childhood caries. It is divided into three
sections. The first section lists journal articles appearing in the
literature between 2002 and 2004. The second section describes the
following types of materials: books, curricula, manuals, modules,
guidelines, pamphlets, brochures, and videotapes. The third section
lists federal agencies and national organizations that may serve as
resources.

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